Will skin continue to shrink after second rhinoplasty?

Question

Hello, I originally had a very large nose. The bridge was lowered, the tip was rotated up and deprojected about 3-4mm. It was also narrowed quite a bit. My skin is thick but it draped quite well. However, it is still quite large as evidenced by the way people continue to treat me... The nose looks good, its just too long. If I got another reduction to reduce the length from bridge to tip, will the skin continue to shrink and redrape or will I be left with a polybleak deformity?

Ali Sajjadian, MD, FACS · Answer

Hello and thanks for your question.It would be best to wait at least for one year before you can determine the amount of shrinkage.Revision rhinoplasty can improve the shape of the cartilage.Polybeak deformity can be due to variety of reasons including too much scar or too much cartilage left behind...It would be best to follow up with your surgeon and he may suggest placing steriod injection and apply taping to the area.Best,Dr Sajjadian

Robert Kotler, MD, FACS · Answer

Dear gzi768 in Beverly Hills:

I am sorry that your nose is not yet satisfactory to
you.  You did not indicate how long it
has been since the surgery.  You are
correct in being concerned about whether or not a revision rhinoplasty will be
appropriate.  It may be that your skin is
thick and takes a long time to settle down, and that is why you do have to give
it sufficient time.  Also, have the
surgeons used injections or medications to help accelerate the swelling
reduction?  You see, there has to be some
differentiation between swelling of the skin and the possibility that there is
still too much cartilage left inside your nose. 
That is the most important evaluation to be made.  An experienced surgeon can tell the
difference.  The most important thing is
evolution over time.  If after 3-4 months
the nose is no longer changing, that does not bodewell for any further
shrinkage of the skin.  At that point,
you probably cannot blame it on the skin. 
It may be that you need to have a little revision but it would not
necessarily be a major revision.

You will want to do a lot of homework before you go for
consultation, but of course consult with the surgeon operated on your.  He wants you to be satisfied, of course.  Should you go for other opinions, which is of
course advisable, study up by reviewing the other doctors’ websites, look
carefully at the before and after photos. 
Look at the section on nonsurgical revision rhinoplasty.  Some rhinoplasties are helped by filler
injections and some are helped by “shrinkage” injections.  It is very important that you get a sense of
what can be done, perhaps, without surgery. 
Of course, that would be ideal, if possible, but it may not be.

Look at the reviews that the patient’s are posting about
the doctor.  Spend a lot of time looking
at the doctor’s resume to determine if he is a “super specialist” in revision
cosmetic nasal surgery or in the nonsurgical techniques of revision rhinoplasty.  All of the homework you do upfront will be
important and be sure to bring friends and family members with you to your
consultation and prepare well with a written agenda and lots of questions that
may be concerning you.  The time spent
“upfront” before consultation is the most important.  The consultation should be informative,
relaxing, and should, of course, include computer imaging so you and the doctor
can all be working off the same page.

Best wishes,

Robert
Kotler, MD, FACS

Over
4,500 nasal procedures performed

William Portuese, MD · Answer

Revision rhinoplasty is a very difficult procedure, so is very important to have a full set of pictures and an in-person examination to discuss all the risks and complications with a  very complicated operation.  A poly-beak deformity can be created from a variety of different issues such as thick skin, scar tissue, fluid retention, and residual cartilage.  Cortisone shots and taping and help  prevent that from occurring in the first year during the postoperative healing phase.

William A. Wallace, MD, FACS · Answer

It can take up to a year to see the final results after a rhinoplasty due to the oily nature of the skin of the nose. If it has been less than a year, continue to find patience. Your nose skin won't sag like skin in other areas. A polybeak deformity isn't due to an excess of skin but rather to the cartilage architecture underneath.

Richard Ellenbogen, MD (retired) · Answer

When the framework is removed from a nose it shrinks. The thick skinned noses shrink much less  but the shrinkage continues indefinitely.

Michael Elam, MD (retired) · Answer

Dear gzi768, I am not sure how far post surgery you are however you will want to wait at least a year to consider revision and often times even longer depending on the thickness of the skin. In a revision procedure the nose can be shortened and the skin will not be lax over the nose. A poly beak deformity is not related to excess skin. A consultation and examination discussing what changes you want will be able to open the line of communication so your surgeon can tell you what is a probable outcome of a revision procedure. Best regards, Michael V. Elam, M.D.

Will skin continue to shrink after second rhinoplasty?

Answers (6)

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